Hanifin-Rajka Criteria
Published by Hanifin and Rajka in 1980 (Acta Derm Venereol), these were the first widely used diagnostic criteria for Atopic Dermatitis. Diagnosis needs three of four major features and three of 23 minor features (Healio; Napolitano et al., 2022). The four major features are: (1) pruritus (itch); (2) typical morphology and distribution, meaning facial and extensor involvement in infants and children and flexural lichenification later; (3) a chronic or chronically relapsing course; and (4) a personal or family history of atopy (asthma, allergic rhinitis, AD) (Napolitano 2022).
Hanifin-Rajka Criteria [defines] Atopic Dermatitis
Minor features. The 23 minor features are a mix of non-specific findings. They include xerosis (dry skin), raised serum IgE, early age of onset, a tendency to skin infections, Dennie–Morgan infraorbital folds, palmar hyperlinearity and Pityriasis Alba (Türe Avcı et al., Children 2026). The later AAD consensus groups Keratosis Pilaris, pityriasis alba, hyperlinear palms and Ichthyosis Vulgaris together as “associated features” (Napolitano 2022). Several minor features are non-specific, such as pityriasis alba, and others are fairly specific but rare, such as upper-lip cheilitis (Healio). Some, such as raised IgE, need a blood test.
Pityriasis Alba [part-of] Hanifin-Rajka Criteria Keratosis Pilaris [relates] Hanifin-Rajka Criteria
Use today. The criteria are thorough but unwieldy. In a review of drug RCTs from 2007 to 2016 they were the most-used criteria (41%), well ahead of the UK Working Party Criteria (9%) and AAD criteria (3.8%) (Healio, citing Vakharia 2018). The AAD 2003 consensus criteria (Eichenfield et al.) streamlined them into essential, important and associated features that can be applied at any age. China developed separate criteria in 2019 for children aged 1–7, after finding Hanifin–Rajka and UK criteria not sensitive enough for milder childhood AD (Healio). For a toddler, many minor features (lichenification, palmar lines, cheilitis) have not yet developed, so the UK or AAD sets are more practical. In everyday care most guidelines rely on an experienced clinician’s assessment (Napolitano 2022).
UK Working Party Criteria [part-of] Hanifin-Rajka Criteria American Academy of Dermatology [relates] Hanifin-Rajka Criteria
Connections
- Atopic Dermatitis — defines, source: AAD 2014
- UK Working Party Criteria — simplified derivative, source: Healio; Napolitano 2022
- American Academy of Dermatology — 2003 revised consensus criteria, source: Healio
- Keratosis Pilaris — associated feature (AAD grouping), source: Napolitano 2022
- Ichthyosis Vulgaris — associated feature (AAD grouping), source: Napolitano 2022
- Pityriasis Alba — non-specific minor criterion, source: Healio
- Differential Diagnosis of Toddler Eczema — criteria help separate AD from mimics, source: Türe Avcı 2026